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A Journal on Surgery

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Chirurgia 2004 December;17(6):209-14


language: English

Diagnosis and treatment of pancreatic trauma

Bonariol L., Massani M., Caratozzolo E., Recordare A., Callegari P., Bassi N.


Aim. Pancreatic trauma is rare but associated to high mortality and morbidity rates, because of delayed recognition and elevated risk of other intra-abdominal associated lesions. All patients with pancreatic trauma were retrospectively identified with the aim of stressing the difficulties in its diagnosis and treatment. Injuries were graded and the method of diagnosis and treatment studied.
Methods. Nine patients were included in the study. Blunt trauma was the most frequent cause of pancreatic injury and only 1 patient had stab wound. Associated lesions were present in 7 patients.
Results. Six patients had pancreatic injury of grade II, 1 patient grade I and 2 patient grade III. Initial amylases and lipases were normal in all patients. The diagnosis was made at laparotomy in 3 cases. Computed tomography (CT) scan was performed in 7 patients, but it failed to recognize a distal pancreas fracture (grade III) in 1 case. Six patients underwent exploratory laparotomy but in 5 there weren't specific pancreatic indications before surgery. Only 1 patient was operated with the intention to treat a suspected distal pancreatic fracture (grade III), 3 patient were treated conservatively. Mortality rate was 0% and 2 patients had post-operative complications.
Conclusion. An alerted approach is required, in case of severe upper abdominal trauma, for proper recognition and management of pancreatic injury whose ductal involvement cannot be definitely excluded on CT.

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